Reducing Prescription Opioid Misuse and Abuse with Urine Drug Testing

使用慢性阿片类药物治疗慢性疼痛的人数在2008年急剧增加， 近年随着类阿片使用的增加， 处方阿片类药物误用和滥用。慢性阻塞性肺疾病治疗的临床实践指南 疼痛建议筛查处方阿片类药物滥用与尿液药物测试（UDT）为所有 患者在开始阿片类药物治疗前和治疗期间定期进行。如果患者有异常的 UDT结果应进行适当的随访。然而，不到25%的患者 处方的慢性阿片类药物治疗接受UDT，没有经验数据可用于如何 提供者在异常UDT后改变临床治疗。拟议的研究将 采用混合研究方法研究UDT和管理滥用药物的患者的方法 处方阿片类药物该提案的具体目标是：（1）在全国患者样本中， 估计UDT的发生率并确定与使用UDT相关的变量，（2） 与临床医生进行定性访谈，探讨对UDT障碍的看法， 管理具有异常UDT结果的患者的方法，以及（3）描述当前的临床 异常UDT结果后的实践。这些结果将为开发更大的 执行研究，旨在增加UDT的使用，并协助供应商管理 有异常UDT结果的患者。这项研究的长期目标是确保 安全使用并减少处方阿片类药物的可预防危害。

The use of chronic opioid therapy for the treatment of chronic pain has increased dramatically in recent years. With the increase in the use of opioids, there has been a concomitant rise in prescription opioid misuse and abuse. Clinical practice guidelines for the treatment of chronic pain recommend screening for prescription opioid misuse with urine drug testing (UDT) for all patients prior to initiating opioid therapy and regularly during treatment. If patients have aberrant UDT results appropriate follow-up should ensue. However, less than 25% of patients who are prescribed chronic opioid therapy receive UDT and no empirical data are available about how providers alter clinical treatment following an aberrant UDT. The proposed research study will employ mixed research methods to study UDTs and methods for managing patients who abuse prescription opioids. The specific aims of this proposal are: (1) in a national sample of patients, estimate the incidence of UDT and identify variables associated with the use of UDT, (2) conduct qualitative interviews with clinicians to explore perceptions of barriers to UDT and methods for managing patients with aberrant UDT results, and (3) describe current clinical practice following an aberrant UDT result. These results will inform the development of a larger implementation study designed to increase the use of UDTs and assist providers in managing patients who have aberrant UDT results. The long-term goal of this research is to ensure the safe use and reduce preventable harm from prescription opioid medications.